Monoamniotic twins with complications and their outcome: case series
Keywords:Monoamniotic twins, TRAP, TAPS, PIH, Multiparous, PPH, Preterm births, Acardiac acephalus
Monoamniotic twins are identical twins sharing the same amniotic sac and placenta, with two separate umbilical cords. Although uncommon, monoamniotic twins are associated with high antenatal and perinatal morbidity and mortality. We present here a series of three cases of monoamniotic twin gestations with fetal complications who delivered in our hospital over a period of one month. Our first case Mrs. ABC with 33 weeks of gestation with Monoamniotic twins presented with twin anemia polycythemia sequence, second case, Mrs XYZ presented as primigravida with 35 weeks of gestational age with monoamniotic twins with severe preeclampsia presented with Cord entanglement who went into postpartum hemorrhage and was conservatively managed for the same. Our third case, Mrs. DEF G2P1L1 with previous scar 1.5 years back with 23 weeks of gestation with monoamniotic twins presented with Twin reversal arterial perfusion sequence and underwent medical termination of pregnancy.
Wladimiroff JW, Eik-Ned S. Ultrasound in obstetrics and gynecology. Elsevier Science Health Science div. 2009;1.
Glinianaia SV, Rankin J, Khalil A, Binder J, Waring G, Sturgiss SN et al. Prevalence, antenatal management and perinatal outcome of monochorionic monoamniotic twin pregnancy: a collaborative multicenter study in England, 2000-2013. Ultrasound Obstet Gynecol. 2019;53(2):184-92.
Madsen C, Sogaard K, Zingenberg H, Jorgensen FS, Rosbach H, Hoseth E et al. Outcomes of monoamniotic twin pregnancies managed primarily in outpatient care-a Danish multicenter study. Acta Obstet Gynecol Scand. 2019;98(4):479-86.
Lewi L, Deprest J, Hecker K. The vascular anastomosis in monochorionic twin pregnancies and their clinical consequences. Am J Obstet Gynecol. 2013;208(1):19.
Shulman LS, Van Vugt JM. Prenatal medicine. Washington, DC: Taylor and Francis. 2010;447.
Tollenaar LSA, Slaghekke F, Lewi L, Colmant C, Lanna M, Weingertner AS et al. Spontaneous twin anemia polycythemia sequence. Am J Obstet Gynecol. 2021;224(2):213.e1-11.
Steffensen TS, Gilbert-Barness E, Spellacy W, Quintero RA. Placental pathology in trap sequence: clinical and pathogenetic implications. Fetal Pediatr Pathol. 2008;27(1):13-29.
Eserdag S, Zulfikaroglu E, Ozer A. Cord entanglement in monochorionic monoamniotic twins. Bratisl Lek Listy. 2010;111(12):673-5.
Santana DS, Cecatti JG, Surita FG. Twin Pregnancy and Severe Maternal Outcomes: The World Health Organization Multicountry Survey on Maternal and Newborn Health. Obstet Gynecol. 2016;127:631.
Delabaere A, Bouchet P, Sendy F, Petillon F, Gallot D. Management of monoamniotic twin pregnancies: Where, when, how? J Gynecol Obstet Hum Reprod. 2022;51(1):102232.
Ezra Y, Shveiky D, Ophir E, Nadjari M, Eisenberg VH, Samueloff A, et al. Intensive management and early delivery reduce antenatal mortality in monoamniotic twin pregnancies. Acta Obstet Gynecol Scand 2005;84:432-5.
Dias T, Mahsud-Dornan S, Bhide A, Papageorghiou AT, Thilaganathan B. Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obstet Gynecol. 2010;35(2):201-4.
Van Mieghem T, De Heus R, Lewi L, Klaritsch P, Kollmann M, Baud D et al. Prenatal management of monoamniotic twin pregnancies. Obstet Gynecol. 2014;124:498-506.
Tannirandorn Y, Phaosavasdi S. Accuracy of ultrasonographic criteria for the prenatal diagnosis of placental amnionicity and chorionicity in twin gestations. J Med Assoc Thai. 1993;76:190.
Diehl W, Hecher K. Selective cord coagulation in acardiac twins. Semin Fetal Neonatal Med. 2007;12(6):458-63.
Genova L, Slaghekke F, Klumper FJ, Middeldorp JM, Steggerda SJ, Oepkes D et al. Management of twin anemia-polycythemia sequence using intrauterine blood transfusion for the donor and partial exchange transfusion for the recipient. Fetal Diagn Ther. 2013;34:121-6.